Is it ok to conduct open rhinoplasty under local anesthesia?

Question from "is it ok to conduct open rhinoplasty under local anesthesia?": I have had 4 consultations: 7yrs, 7yrs, 10yrs, and 26yrs (experience of each dr.)Two stated iv sedation, one stated general anesthesia. The 26yr doctor stated local. He stated too much risk with iv and general., I guess from experience? He would have me on ambiean, Valium etc.. 1.5 -2hr it will take. The 26yr doctor said i have a on a scale of 1-10 difficulty of doing , would be a 4. The other doctors said difficulty, and it would be an 8. Why would this doctor of 26yrs be so confident he can conduct rhinoplasty under local anesthesia?

Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore: 

Dear "is it ok to conduct open rhinoplasty under local anesthesia?"

Yes, but it may not be your safest option. Rhinoplasty surgery requires skill and finesse, particularly in an area of the body where you breathe. With rhinoplasty under local anesthesia, you will hear (music, conversation), feel (not pain necessarily but pushing, pulling, banging) and may not be properly monitored. Should there be bleeding or active secretions or changes in your heart or breathing vital signs, your surgeon will require the skills to multi-task beyond the talents of a nose surgeon.

Most of my rhinoplasty surgery is performed under General Endotracheal Anesthesia to protect the airway and have a select anesthesia provider provide the best experience and safety for your welfare.

Below is an opinion article from the American Society of Aesthetic Plastic Surgery discussing the virtues and concerns of different anesthetics.

I hope this is helpful. All the best!

Dean Kane, MD, FACS

Local Anesthesia and Plastic Surgery: Marketing or Reality?

December 9, 2014

Local Anesthesia and Plastic Surgery: Marketing or Reality?

• The following article by Heather J. Furnas MD is added to the www.DrDeanKane.com website because it is a timely and important opinion which I would like to make available to any patient interested in Dean Kane, MD, FACS’s services

An increasing number of patients ask to have their surgery done with local anesthesia “because it’s safer.” Guess what? That isn’t always the case.

Plastic surgery procedures tend to have clever names: Mommy Makeover, Insta-Boob, Cinderella Surgery... but the operative (no pun intended) word here is surgery. All of the above-referenced procedures are invasive; in the example of the Mommy Makeover, it can include several procedures to achieve the desired result. That means at some point, your body is cut open so the operation can be performed. The Mayo Clinic has weighed in on the use of general anesthesia, explaining it should be considered if your operation:

• Takes a long time

• Exposes you to a cold environment

• Affects your breathing, such as chest or upper abdominal surgery.

They also state that: “Most healthy people don't have any problems with general anesthesia. Although many people may have mild, temporary symptoms, general anesthesia itself is exceptionally safe, even for the sickest patients. In general, the risk of complications is more closely related to the type of procedure you're undergoing, and your general physical health, than to the anesthesia itself.”

So why aren’t patients asking for it? Two reasons come to mind. The first is the need for additional information about the procedure, including any risks or complications that could potentially arise.

This we can provide.

The second is more disturbing, because it seems to correlate with the increasing number of doctors who aren’t plastic surgeons, but who perform cosmetic surgeries learned at weekend courses taught by other non-plastic surgeons.

This we have to fix.

The main selling point for their practice is that they do plastic surgery “under local anesthesia.”

Love the Local Anesthesia–Too Bad It Was the Wrong Procedure!

The problem with choosing a specific procedure solely because it can be done under local anesthesia is that your surgeon may not be offering you the correct procedure or the safest path to your desired result. Why? Because that doctor may not know how to do it.

If a doctor can only do liposuction under local anesthesia, but you need a tummy tuck, he may tell you liposuction is your only safe option. We see many patients who are unhappy after a non-plastic surgeon left them with loose, lumpy skin. They lost time and money, and they still need a tummy tuck to address their specific concerns.

Mini Tummy Tuck and the Sad-Faced Belly Button

Similarly, many doctors perform “mini tummy tucks” under local anesthesia “because it’s safer,” even on patients who need full tummy tucks under general anesthesia. Those patients consult with us, wondering why their belly button is pulled down and their tummy still bulges. They received the local anesthesia they wanted, but they also received the wrong operation.

Drooping Breasts Don’t Lift Themselves

Patients wanting a breast lift often come to us after a non-plastic surgeon gave them breast implants. The patient had the “safe operation under local anesthesia” because the initial doctor didn’t know how to perform a breast lift. Patients come to us to find out if their breasts can be fixed.

Why Would a Doctor Use Only Local Anesthesia?

If a doctor only promotes local anesthesia, ask yourself these questions:

•Is the doctor a board-certified plastic surgeon who operates in an accredited operating room and has hospital privileges?

• Is he/she fully experienced in all aesthetic procedures of the face and body?

• Does he/she only offer local anesthesia because an anesthesiologist won’t come to an office without an accredited operating room?

• Is it better to have the wrong operation under local anesthesia than the correct one under general anesthesia?

Local anesthesia is cheaper and is generally safe, but it’s not infallible. Even without sedation, fatalities can result from toxic levels of local anesthesia, limiting how much can be safely done.

Do You Want the Best Procedure or the One Done under Local?

All board-certified plastic surgeons are trained to do procedures under general anesthesia as well as local anesthesia with and without sedation. As board-certified plastic surgeons, we won’t offer you the incorrect procedure under the guise of “safety” because we don’t know how to do the correct one.

Protect yourself, and ask questions.